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General NPI Number Information
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NPI Number | 1508121377
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Entity Type | Organization
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Legal Business Name | RYE ACTIVE CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 31 PURCHASE ST SUITE 2-3
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City | RYE
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State | NY
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Zip | 10580-3013
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Country | US
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Telephone | 914-409-8385
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Fax |
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Provider Business Mailing Address
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Address Line | 31 PURCHASE ST SUITE 2-3
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City | RYE
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State | NY
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Zip | 10580-3013
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Country | US
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Telephone | 914-409-8385
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. STEPHANIE LORD
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Credential | DC
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Telephone | 914-409-8385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X012102
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License Number State | NY
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